Repeat surgical intervention after aortic repair for acute Stanford type A dissection

Objective This study aimed to evaluate the outcomes of repeat interventions on the aorta and aortic valve after surgery for acute Stanford type A aortic dissection. Methods The hospital records of patients who underwent repeat surgical intervention between April 2011 and March 2017 for late complica...

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Bibliographic Details
Published in:General thoracic and cardiovascular surgery 2018-12, Vol.66 (12), p.692-699
Main Authors: Kitamura, Tadashi, Torii, Shinzo, Kobayashi, Kensuke, Tanaka, Yuki, Sasahara, Akihiro, Araki, Haruna, Ohtomo, Yuki, Horikoshi, Rihito, Miyaji, Kagami
Format: Article
Language:English
Subjects:
Acute Disease
Aged
Anastomosis, Surgical - adverse effects
Aneurysm, Dissecting - physiopathology
Aneurysm, Dissecting - surgery
Anticoagulants
Aorta - physiopathology
Aortic Aneurysm - physiopathology
Aortic Aneurysm - surgery
Aortic dissection
Aortic Valve - physiopathology
Aortic Valve Insufficiency - surgery
Blood transfusions
Cardiac Surgery
Cardiology
Coronary vessels
Dilatation, Pathologic - surgery
Dissection
Emergencies
Female
Hemorrhage
Hospitals
Humans
Male
Medical records
Medicine
Medicine & Public Health
Middle Aged
Original Article
Ostomy
Patients
Pseudoaneurysm
Reconstructive Surgical Procedures
Reoperation
Retrospective Studies
Surgeons
Surgery
Surgical Oncology
Thoracic Surgery
Vascular Surgical Procedures - methods
Veins & arteries
Ventilators
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Summary:Objective This study aimed to evaluate the outcomes of repeat interventions on the aorta and aortic valve after surgery for acute Stanford type A aortic dissection. Methods The hospital records of patients who underwent repeat surgical intervention between April 2011 and March 2017 for late complications after acute type A aortic dissection repair were retrospectively reviewed. Results We identified 17 patients with mean age of 62 ± 8 years; 13 were men. The mean interval from the initial emergency aortic repair to the repeat intervention was 5.8 ± 5.4 years (range 133 days–16.6 years). Ten patients had dilatation or rupture of the residual type B aortic dissection; six of them had retrograde type A aortic dissection at the onset and did not undergo resection of the primary entry. Five patients had a pseudoaneurysm at the anastomosis; four of them were receiving anticoagulation medication. Three patients had aortic regurgitation; two of them were associated with the gelatin-resorcinol-formaldehyde glue that was used during the initial surgery. There was no early mortality after repeat intervention and no late death after a mean follow-up period of 3.3 ± 2.0 years. Conclusions Repeat surgical intervention on the aorta and aortic valve after repair of acute type A aortic dissection had favorable early and mid-term outcomes and was not associated with early or late death. Long-term follow-up with imaging and echocardiography was considered to be essential for early detection of residual type B dilatation, anastomotic pseudoaneurysm, and aortic regurgitation after initial aortic repair.
ISSN:1863-6705
1863-6713
DOI:10.1007/s11748-018-0983-1